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Paradoxical embolism in the left main coronary artery: diagnosis by transesophageal echocardiography

Hans K Meier-Ewert1, Sherif B Labib, Edgar C Schick

  • 1Department of Cardiovascular Medicine, Lahey Clinic Medical Center, Burlington, Mass 01805, USA.

Mayo Clinic Proceedings
|January 17, 2003
PubMed

Insights

A patient experienced a stroke and heart attack due to a paradoxical coronary embolism, a rare condition diagnosed via transesophageal echocardiography. Surgical removal of the clot was successful, offering new insights into this cardiovascular event.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Surgery

Background:

  • Paradoxical embolism occurs when a clot travels from the venous to the arterial system, bypassing the lungs.
  • Coronary artery embolism is a rare cause of myocardial infarction and stroke.

Observation:

  • A patient presented with acute stroke and subsequent myocardial infarction.
  • Coronary angiography revealed left main coronary artery obstruction.
  • Transesophageal echocardiography visualized a thrombus traversing a patent foramen ovale and obstructing the coronary ostium.

Findings:

  • Direct echocardiographic visualization of a paradoxical coronary embolism was achieved.
  • Surgical retrieval of the coronary thrombus and the patent foramen ovale thrombus was successful.
  • The patient's neurological and cardiac events were attributed to paradoxical embolism.

Implications:

  • This case highlights the diagnostic utility of transesophageal echocardiography in identifying paradoxical coronary embolism.
  • Early surgical intervention can be effective in managing this critical condition.
  • Understanding the mechanisms of paradoxical coronary embolism is crucial for prevention and treatment strategies.

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